# 出血（Hemorrhage）

- 器官 / 系统：脾脏 / 免疫系统（spleen / immune-system）
- NTP 数据编号：ntp-0030
- 规范 URL：https://www.labsmart.cn/ntp/spleen-hemorrhage.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#spleen-hemorrhage
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/immune-system/spleen/Hemorrhage
- 授权：美国联邦政府作品，公有领域；引用请标注 NTP Nonneoplastic Lesion Atlas
- 适用说明：仅供科研使用，不用于临床诊断

## 一句话结论
出血（hemorrhage）的特征是脾被膜内（Figure 1，箭头）或脾实质内（Figure 2，箭头）出现外渗的红细胞。

## 病变描述（中文）
出血（hemorrhage）的特征是脾被膜内（Figure 1，箭头）或脾实质内（Figure 2，箭头）出现外渗的红细胞。出血可为局灶性（focal）至弥漫性（diffuse），并可发生于多种情况下（例如脾梗死）、化学物暴露后、继发于照射或创伤性损伤，以及与恶性肿瘤尤其是血管肉瘤（hemangiosarcoma）相关。脾血肿是血管外血液的局限性聚集，被视为出血的一个亚型（Figure 1，箭头）。脾出血应与血管扩张（angiectasis）、充血（congestion）、血管瘤（hemangioma）和血管肉瘤相鉴别。血管扩张通常是脾内的局灶性病变，并可能与纤维化区域相关。其大小不等的充满血液的腔隙由内皮衬覆。充血可能难以与出血相区分。充血通常局限于红髓窦，可能有也可能没有可识别的原因。血管瘤和血管肉瘤是脾血管内皮肿瘤。

## 诊断与分级建议（NTP 共识，中文）
脾内凡出现出血，均应作出诊断并分级。脾血肿不应单独诊断，而应诊断为出血。若出血继发于脾肿瘤，则无需诊断，但应在病理描述中注明。

## 英文原文 · Comment
Hemorrhage is characterized by the presence of extravasated erythrocytes within the splenic capsule ( Figure 1 , arrow) or parenchyma ( Figure 2 , arrow). Hemorrhage can be focal to diffuse and may occur in a variety of conditions (e.g., splenic infarction), following chemical exposure, secondary to irradiation or traumatic injury, and in association with malignant neoplasms, especially hemangiosarcoma. A splenic hematoma is a localized collection of blood outside of blood vessels and is considered a subset of hemorrhage ( Figure 1 , arrow). Hemorrhage in the spleen should be distinguished from angiectasis, congestion, hemangioma, and hemangiosarcoma. Angiectasis is usually a focal lesion in the spleen and may be associated with an area of fibrosis. Its variably sized blood-filled spaces are lined by endothelium. Congestion can be difficult to differentiate from hemorrhage. Congestion is typically confined to the red pulp sinuses and may or may not have an identifiable cause. Hemangiomas and hemangiosarcomas are neoplasms of the splenic vascular endothelium.

## 英文原文 · Recommendation
Whenever present in the spleen, hemorrhage should be diagnosed and graded. Splenic hematomas should not be diagnosed separately but diagnosed as hemorrhage. Hemorrhage need not be diagnosed if secondary to splenic neoplasia but should be noted in the pathology narrative.

## 配图
- https://www.labsmart.cn/ntp-atlas-images/ntp_0443.jpg
- https://www.labsmart.cn/ntp-atlas-images/ntp_0433.jpg

整理：北京天融慧通科技有限责任公司（LabSmart）｜ https://www.labsmart.cn